Medical Certification Decision Making

AME Guidance, General Information Section 4

Apr 2014

Guidance is compiled and interpreted by professional pilots and physicians at from the 2014 AME Guide pages 8-10, FAA and FDA web data ( &, instructions specified in the Aeronautical Information Manual, Federal Air Surgeon Bulletins from 1999-2015, and 14 CFR Part 61 and Part 67 (the FARs).

The format of the Guide establishes aerospace medical dispositions, protocols, and AME Assisted Special Issuances (AASI) identified in Items 21–58 of the FAA Form 8500. This guidance references specific medical tests or procedure(s) the results of which are needed by the FAA to determine the eligibility of the applicant to be medically certificated. The request for this medical information must not be misconstrued as the FAA ordering or mandating that the applicant undergo testing, where clinically inappropriate or contraindicated. The risk of the study based upon the disease state and test conditions must be balanced by the applicant’s desire for certification and determined by the applicant and their healthcare provider(s).

After reviewing the medical history and completing the examination, Examiners must:

  • Issue a medical certificate,

  • Deny the application, or

  • Defer the action to the Manager, AMCD, AAM-300, or the appropriate Regional Flight Surgeon

Examiners may issue a medical certificate only if the applicant meets all medical standards, including those pertaining to medical history unless otherwise authorized by the FAA.

Examiners may not issue a medical certificate if the applicant fails to meet specified minimum standards or demonstrates any of the findings or diagnoses described in this Guide as "disqualifying" unless the condition is unchanged or improved and the applicant presents written documentation that the FAA has evaluated the condition, found the applicant eligible for certification, and authorized Examiners to issue certificates.

The following medical conditions are specifically disqualifying under 14 CFR part 67. However, the FAA may exercise discretionary authority under the provisions of Authorization of Special Issuance, to issue an airman medical certificate. See Special Issuances section for additional guidance where applicable.

  • Angina pectoris;

  • Bipolar disorder;

  • Cardiac valve replacement;

  • Coronary heart disease that has required treatment or, if untreated, that has been

    symptomatic or clinically significant;

  • Diabetes mellitus requiring insulin or other hypoglycemic medication;

  • Disturbance of consciousness without satisfactory medical explanation of the cause;

  • Epilepsy;

  • Heart replacement;

  • Myocardial infarction;

  • Permanent cardiac pacemaker;

  • Personality disorder that is severe enough to have repeatedly manifested itself by overt acts;

  • Psychosis;

  • Substance abuse and dependence;

  • Transient loss of control of nervous system function(s) without satisfactory medical explanation of cause.

An airman who is medically disqualified for any reason may be considered by the FAA for an Authorization for Special Issuance of a Medical Certificate (Authorization). For medical defects, which are static or nonprogressive in nature, a Statement of Demonstrated Ability (SODA) may be granted in lieu of an Authorization.

The Examiner always may defer the application to the FAA for action. In the interests of the applicant and of a responsive certification system, however, deferral is appropriate only if the standards are not met; if there is an unresolved question about the history, the findings, the standards, or agency policy; if the examination is incomplete; if further evaluation is necessary; or if directed by the FAA.

The Examiner may deny certification only when the applicant clearly does not meet the standards.

This page discussed the Decision Making portion of the AME Info section of the Fight Physical Examination required of pilots.

Reminder: use to familiarize yourself with aviation medical regulations and guidelines, but always discuss your specific situation with one or more AMEs before dedicating resources toward expensive clinical workups. Find an AME now